At-Home Monitoring May Help People With AMD Protect Their Vision

By Reena Mukamal for the American Academy of Ophthalmology

For roughly 1.5 million Americans living with wet age-related macular degeneration (AMD), regular eye injections are an important part of protecting vision.

Many patients are asked to see their ophthalmologist every month or every other month to keep the disease under control. For many older adults, these frequent visits can be tiring, difficult, or hard to keep up with.

There is an option that may help make care easier and more personalized: a Food and Drug Administration-approved at-home monitoring program for wet AMD.

Devices that let patients use OCT (optical coherence tomography) to check their eyes at home on a regular basis can help. The results can help ophthalmologists see exactly how long a treatment is working in each patient’s eye. This may give doctors and patients more control over managing the disease.

How Wet AMD Causes Vision Loss

Wet AMD is a serious eye disease that affects the macula, the part of the retina responsible for sharp, central vision. In wet AMD, abnormal blood vessels grow under the retina. These vessels can leak blood and fluid, which damages the retina and leads to vision loss.

The most common treatment for wet AMD is a group of medicines called anti-VEGF drugs. These medications slow or stop the growth of abnormal blood vessels and help reduce fluid buildup. Because the medicine wears off over time, it must be injected into the eye on a regular basis by a retina specialist.

To decide when treatment is needed, doctors use a scan called optical coherence tomography (OCT). OCT creates detailed images of the retina and shows whether fluid is present.

“Traditionally, most patients are treated on a monthly or every-other-month schedule to stay ahead of the disease,” said Miguel Busquets, MD, FACS, an investigator in SCANLY clinical trials. “But in reality, some patients could safely wait longer, while others need treatment sooner.”

How At-Home Monitoring Works

One at-home product called the SCANLY Home OCT system and developed by Notal Vision allows patients to scan their eyes at home. Patients receive a small device that sits on a desk or table. The Notal Vision Monitoring Center helps patients set up the device and learn how to use it.

Each scan takes less than one minute and captures about 90 images of the retina. The images are sent securely to a cloud-based system. Artificial intelligence (AI) checks the images for signs of fluid and measures how much fluid is present. Trained clinical staff and the patient’s eye doctor also review the scans at regular times.

Doctors can set alerts to be notified when fluid levels suggest the disease is becoming active again. Patients can then be asked to come in for an exam or treatment exactly when it is needed, instead of following a fixed schedule.

Home Monitoring Products

Home monitoring is not completely new in macular degeneration care. For more than 10 years, patients with intermediate dry AMD have used ForeseeHome, another at-home monitoring system from Notal Vision. ForeseeHome tracks small changes in vision that patients may not notice on their own. This helps doctors detect when dry AMD turns into wet AMD as early as possible.

Early detection may lead to faster treatment. More than 80% of patients who used ForseeHome as part of a clinical study still had usable 20/40 vision when wet AMD was diagnosed. ForeseeHome requires a prescription and usually costs patients between $0 and $80 per month out-of-pocket.

New Era in Wet AMD Care

Clinical trials show that anti-VEGF injections can help more than 90% of patients protect their vision. In real life, however, only about half of patients maintain useful vision over time. One major reason is that patients miss or delay treatments.

Long travel distances, dependence on caregivers, other health problems, and fear of eye injections can all make it hard to stay on schedule. At-home monitoring aims to reduce this burden and help patients receive care when they need it most.

Other recent advances in wet AMD treatment include longer-lasting medications, such as faricimab (Vabysmo) and aflibercept 8 mg (Eylea HD), an implanted drug delivery system (Susvimo), and new treatments under study, including gene therapies.

“With longer-lasting treatments available, home OCT becomes even more valuable,” said Dr. Busquets. “It helps doctors better understand how the disease is responding and helps patients take a more active role in protecting their vision.”

Cost and Availability

SCANLY Home OCT must be prescribed by an ophthalmologist and is not yet widely available. Notal Vision is working with Medicare to establish insurance coverage. Coverage and patient costs may change as this process moves forward. Ask your ophthalmologist about the program.